Provider First Line Business Practice Location Address:
1344 E MISSION RD
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92069-3038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-740-0070
Provider Business Practice Location Address Fax Number:
760-781-1403
Provider Enumeration Date:
10/10/2006